P1657: PATTERNS AND PATIENT SPECIFIC FEATURES CHARACTERIZING BLEEDING EVENTS IN PATIENTS ON ANTIPLATELET AND ANTICOAGULANT THERAPY: A TERTIARY CENTER EXPERIENCE
Authors: H. Awada, A. Hajj Ali, H. Nassereldine, M. Zeineddine
Journal: HemaSphere (2022)

Background: Acute coronary syndrome and atrial fibrillation are among the major causes of morbidity and mortality in society. Treatment of these conditions requires the prescription of oral anticoagulants (OAC) and antiplatelets (AP). These drugs cause an increased risk of developing bleeding, a condition associated with a 60% increased risk of in-hospital death. Aims: Physicians often have to find the balance between preventing the formation of thrombi without causing a significant increase in the bleeding risk of the patient. Here, we report our findings with regards to the incidence and patterns of bleeding admissions at a tertiary care center. Our goal is to identify patient-specific factors that can predict sites of bleeding if it occurs. Methods: We retrospectively reviewed the electronic charts of patients who were admitted for bleeding events at the American University of Beirut Medical Center (AUBMC). Baseline and admission demographic, social and clinical characteristics were obtained. The patients’ history of antiplatelets and anticoagulants was obtained. Sites of bleeding were categorized as Intracranial, Upper gastrointestinal (Upper GI), Lower gastrointestinal (Lowe GI), Respiratory tract, and Genitourinary (GU). Patients who had bleeding with trauma were excluded. Continuous variables are reported as means with standard deviations, while categorical variables are presented as percentages. Categorical variables were compared using the chi-squared test while the t test and ANOVA test were used for analysis of continuous variables. Results: We identified 343 adult patients who were admitted for bleeding at AUBMC. The average age was 72.44 ± 12.53 with a Body Mass Index (BMI) of 27.94 ± 5.17. Off all patient, 17.8% were alcohol users while 28.9% had a history of smoking. Bleeding sites included 23.24% Intracranial, 11% Respiratory, 22.32% Upper GI, 29.35% Lower GI, and 14.06% GU bleeding. Medications included single antiplatelet in 114 patients, dual antiplatelets in 31 patients, single antiplatelet and anticoagulant in 23 patients, and anticoagulant in 74 patients. Patient with older age with significantly more likely to experience Lower GI bleed while on antiplatelet or anticoagulants that at any other site (p=0.009). In contrast, patients with alcohol use were more likely to experience intracranial bleeding events (p=0.012). No difference in bleeding location was noted amongst current smokers, ex-smokers or never smokers (p=0.103) or with BMI levels (p=0.3). Medical history of Hypertension, Diabetes Mellitus or Atrial Fibrillation did not affect bleeding sites. Patients only on anticoagulation were more likely to have lower GI bleed than at other sites (p=0.001), however; no difference in bleeding sites was found in patients on a single antiplatelet, dual antiplatelet, or single antiplatelet and anticoagulation. Summary/Conclusion: Location of bleeding events in patients on antiplatelets or anticoagulants is influenced by age and alcohol use but not smoking. Patient on anticoagulants are most likely to bleed from Lower GI, while no difference in bleeding site exists in patients on single antiplatelet, dual antiplatelet, or single antiplatelet and anticoagulation.